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Religions 2011, 2, 345-357; doi:10.


ISSN 2077-1444

Measuring Religiosity/Spirituality: Theoretical Differentiations

and Categorization of Instruments
Christian Zwingmann 1,*, Constantin Klein 2 and Arndt Bssing 3

The Protestant University of Applied Sciences Rhineland-Westphalia-Lippe, Immanuel-Kant-Str.

18-20, D-44803 Bochum, Germany
Center for the Interdisciplinary Research on Religion and Society (CIRRuS), Faculty for History,
Philosophy, and Theology, University of Bielefeld, Bielefeld, Germany;
Center of Integrative Medicine, University Witten/Herdecke, Gerhard-Kienle-Weg 4, D-58313
Herdecke, Germany; E-Mail:

* Author to whom correspondence should be addressed; E-Mail:;

Tel.: +49-234-36901-108; Fax: +49-234-36901-100.
Received: 29 June 2011; in revised form: 17 July 2011 / Accepted: 9 August 2011 /
Published: 11 August 2011

Abstract: There is a multitude of instruments for measuring religiosity/spirituality. Many

of these questionnaires are used or even were developed in the context of studies about the
connection between religiosity/spirituality and health. Thus, it seems crucial to note that
measures can focus on quite different components along a hypothetical path between stressors and health. We present an instructive model which helps to identify these different
components and allows the categorization of instruments of religiosity/spirituality according to their primary measurement intention: intensity/centrality, resources, needs, coping,
and quality of life/well-being. Furthermore, we point out possibilities as to how religiosity
and spirituality can be differentiated. We argue that the distinction between religiosity and
spirituality is important in countries with a more secular background where a growing
number of people identify themselves as spiritual, but not religious.
Keywords: religiosity; spirituality; questionnaires; categorization

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1. Introduction
Within the last decade, the connection between religiosity/spirituality and health has become a subject of increasing interest particularly within the field of health care [1-3]. A considerable number of
quantitative studies have so far found religious/spiritual variables to be modestly but meaningfully associated with mental or even physical health and psychosocial adjustment [2,4,5]. However, the research results are not entirely consistent; null findings and even negative associations were shown as
well. This may be due to variations in subjects, stressors, or contextual characteristics and may indicate
that religiosity/spirituality, especially religious/spiritual struggle and feelings of shame and guilt [6,7],
can also be part of psychosocial problems. Furthermore, varying results may also reflect the breadth of
indicators and questionnaires used for measuring religiosity/spirituality.
Measures of religiosity/spirituality can focus on quite different components along a hypothetical
path between stressors and health. For instance, many previous studies did not explicitly differentiate
between general religiosity/spirituality and religious coping (cf. [8]). General religiosity/spirituality
refers to the importance of religiosity/spirituality in ones life and can be viewed as a more or less stable disposition that may constitute a resource in the process of coping with various stressors. In contrast, religious coping as an active process describes how individuals draw on their religious faith and
behavior within a specific situation of crisis [8,9]. The separate assessment of both general religiosity/spirituality and religious coping has already proved to be useful: Among members of Christian
churches who envisioned serious negative life events, Pargament et al. [11] found that measures of religious coping not only exhibited greater predictive power than more dispositional religious variables
but also predicted outcomes above and beyond the contribution of general religiosity. Similar results
have emerged from subsequent studies (cf. [9,12,13]).
In this paper we first will present an instructive model which allows us to locate different religious/spiritual components along a hypothetical path between stressors and health. On the basis of this
model we then will show how questionnaires of religious/spiritual issues can be categorized according
to their primary measurement intention. Due to the focus of this Special Issue of Religions and to the
mainstream of contemporary research on religiosity/spirituality and health we concentrate on questionnaires although we are aware that there is a growing body of research using qualitative measures as
well [14,15]. In an additional section we will discuss some proposals as to how religiosity and spirituality can be differentiated. We think that both aspects primary measurement intention and conceptualization of religiosity and spirituality should thoroughly be reflected, if instruments for measuring
religiosity/spirituality have to be selected for a specific study.
2. Integrating Religiosity/Spirituality into the Vulnerability-Stress-Model
In recent years many pathways through which religiosity/spirituality may cause (better) health have
been discussed. Among the first, Peterson and Roy [16] suggested three major pathways: Religiosity/spirituality enables the individual to experience positive emotions like hope, optimism, and solace.
Religiosity/spirituality also offers many opportunities to find a meaning in ones life. Furthermore, religious communities can provide social support. As further pathways, Argyle [17,18] added religious
behavior which fosters a healthy lifestyle (cf. also [19]) and a close relationship with God as a source

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of comfort and self-esteem. Park [20-23] highlighted in particular the importance of religiosity/spirituality as a meaning system and frame of reference, while Drr [24] viewed also alternative
value orientations (e.g., humility, abstinence, social engagement) as a salutary resource of religiosity/spirituality. Among others, Oman and Thoresen [25] further included the concept of religious coping [9,10,26] in the list of possible pathways. Finally, Koenig, McCullough, and Larson [2] distinguished factors on an individual level (such as self-esteem or meaning-making) and social resources
(such as religious communities) from coping strategies which directly try to improve ones health. Additionally, their model includes the occurrence of critical life events and predispositions.
A comprehensive model which would be able to integrate the varieties of pathways mentioned
should, on the one hand, include religiosity/spirituality not only as a single erratic factor whose effects
are mediated by other determinants like social support or health behavior (e.g., [19]). This would surely
ignore the complex dynamics which lie in religiosity/spirituality itself and, thus, would underestimate
the effects of religion. Pargament [27] has called this: explaining religion away. Instead, a comprehensive model should include different aspects of religiosity/spirituality and demonstrate how these
specific facets may interplay and be linked with health. On the other hand, however, a comprehensive
model should not solely concentrate on religious/spiritual factors. This would neglect the predispositions and consequences of the multi-shaded religious/spiritual variables (e.g., [19]) and, thus, fail to
link the study of religiosity/spirituality to more general models of saluto- or pathogenesis.
To consider both taking the inner dynamics of religiosity/spirituality into account and linking the
study of religiosity/spirituality to the mainstream of medical and psychological research, we would like
to propose integrating elaborated concepts of religiosity/spirituality into a widely accepted model of
pathogenesis, the vulnerability-stress-model [28,29]. The resulting model is depicted in Figure 1 (for
more detailed introduction see [30,31]).
Figure 1. Vulnerability-stress-model, integrating various aspects of religiosity/spirituality
along a path between stressors and health (adapted in a modified version from [30,31]).
The numbers one to five denote the components for which specific questionnaires of religiosity/spirituality exist (see section 3).





intensity or
of religion



health behavior





The model in Figure 1 can be explicated as follows: According to the vulnerability-stress-model,

health is the result of the individuals reactions to diverse challenges like critical life events, daily hassles, and chronic stressors. The result of this process of reactions depends on the interaction of several
factors involved. Among these factors are basic predispositions on the environmental level, for instance, the individuals socialization, as well as on the individual level, for instance, the individuals

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hereditary dispositions. Further, the existence and availability of social and individual resources determine how successfully the challenges can be handled. Regarding religiosity/spirituality, the religious community can be viewed as a social resource, while religious beliefs which generate a basic
sense of coherence may represent an individual resource. Even religious entities like God, the Virgin
Mary, angels or non-Christian entities like Buddha can function as social resources on an imaginative
level [11] whether they really exist or not does not matter here because the very impression that they
guide and help may already yield (healthy) effects. Whereas predispositions and resources do not concretely deal with challenges, specific coping strategies are the active processes to handle the burden of
the challenges more directly. As a result, the complex interplay between the different types of factors
determines the individuals status of health or illness. Besides the two groundbreaking dimensions of
health or well-being i.e., the physical status and the psychosocial or mental status some authors introduced the concept of spiritual well-being as a further dimension [32,33]. This concept may involve
various aspects such as faith, peace, and meaning [34,35], or may be divided into four domains: personal, communal, environmental, and transcendental [36,37].
In consideration of the multitude of findings already supporting a positive correlation between general religiosity and mental health (e.g., [38]), the intensity or centrality of religiosity [39,40] is prominently integrated into our model. Intensity/centrality of religiosity can be perceived as both a personality trait and a resource for coping. Consequently, our model introduces intensity/centrality as an overlapping construct in between predispositions and health resources. It should be noted that intensity/centrality of religiosity encompasses several distinct expressions of religious life, in particular an
intellectual dimension, ideology, public and private practice, and religious experience [39,41,42]. The
more differentiated religious expressions a person has developed the stronger his or her general religiosity is.
Within the religious coping behavior, three main components can roughly be distinguished: Coping
behavior may be triggered by religious/spiritual needs and can be separated into a healthy lifestyle influenced by specific religious precepts or ethics on the one hand (more preventive), and, on the other
hand, religious coping activities which directly try to cope with manifest health problems
(more intervening).
3. Relating Measures of Religiosity/Spirituality to Components of the Model
On the basis of the model depicted in Figure 1 questionnaires of religiosity/spirituality can be related to distinct components of our model and, thus, categorized according to their primary measurement intention (cf. [43]): intensity/centrality, resources, needs, coping, and quality of life/well-being
(see No. 15 in Figure 1):
Intensity/centrality (see No. 1 in Figure 1): In this area, the intensity/centrality of religiosity/spirituality is brought into focus. Thus, measures in this area have to address the question: How religious/spiritual is the respondent? To answer this question a great variety of questionnaires of diverse
provenience were proposed. The presumably most classical example is the intrinsic subscale of Allports Religious Orientation Scale (ROS; [44]) which is often used not only as a measure of intrinsic
religiousness as opposed to extrinsic religiousness but also as an indicator of religiosity in general [45].
A well-elaborated and conceptual very clear operationalization of the intensity/centrality aspect is the

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Centrality Scale (C-Scale) recently developed by Huber [39,46] which combines Allports concept of
intrinsic religiousness with Glocks idea of several distinct expressions of religious life. Though many
other scales also intend to measure the aspect of intensity/centrality, they often address another component or even several other components of our model as well. Insofar as these measures essentially
mix up diverse aspects, they cannot strictly speaking be considered as unequivocal operationalizations of intensity/centrality. Finally, it should be pointed out that there are scales which focus on specific expressions of intensity/centrality. In particular, the dimension of religious experience has often
been operationalized separately (e.g., [47,48]). Scales for the assessment of religious/spiritual experience inquire to what extent religious/spiritual experiences have been encountered.
Resources (see No. 2 in Figure 1): Religious/spiritual scales related to the area of resources should
primarily focus on global supporting functions of religiosity/spirituality. The central question is: How
and to what extent does the respondents religiosity/spirituality provide resources for coping with burden? Social resources (e.g., support by the religious congregation) can be distinguished from individual resources (e.g., a close relationship with God, the Divine, etc.). An example for a scale which includes both of these aspects is the System of Belief Inventory (SBI; [49]) which comprises a subscale
Social Support from a Religious Community and another subscale Beliefs and Practices measuring
the relationship with God. Many other scales deal with individual resources only, for instance the
Theistic Spiritual Outcome Scale (TSOS; [50]).
Needs (see No. 3 in Figure 1): Scales operationalizing religious/spiritual needs highlight the question: Does a person who is already suffering experience religious or spiritual needs? The fulfillment of
religious/spiritual needs, e.g. by healthcare professionals, can enhance religious coping behavior and
thus improve a persons well-being, especially his or her religious/spiritual well-being. Examples of
scales measuring religious/spiritual needs are the Spiritual Needs Inventory (SNI; [51]) and the Spiritual Needs Questionnaire (SpNQ; [52,53]).
Coping (see No. 4 in Figure 1): Scales measuring religious coping try to identify concrete religious/spiritual strategies and activities which are used to deal with current problems, in particular critical life events and experiences of severe illness. The central questions in this area are: How does the
person concerned use religiosity/spirituality to cope with his or her burden? Does he or she use specific
religious coping strategies? Several scales measuring facets of religious coping have been developed in
recent years; the most prominent ones are those of Pargament and colleagues: the Brief Measure of Religious Coping (Brief RCOPE; [54]), the extended Religious Coping Scales (RCOPE; [55]), and the
Religious Problem Solving Scale (RPSS; [56]) which differentiates three specific religious coping
Quality of Life and Well-being (see No. 5 in Figure 1): Scales in this area focus on religious/spiritual well-being and quality of life as an aspect of general well-being or quality of life. The
underlying central question is: How can someones religiosity/spirituality before or after an intervention or within the process of illness and recovery be described as a facet of his or her subjective
health? Examples for scales in this area are the Spiritual Well-Being Scale (SWBS; [57,33]), the Spiritual Well-Being Questionnaire (SWBQ; [58,59]), and The Functional Assessment of Chronic Illness
Therapy Spiritual Well-Being Scale (FACIT-Sp; [60,61]). However, if such scales are used as outcome measures for religious/spiritual interventions, their contents have to be discussed very precisely
to avoid an overestimation of salutogenetic effects due to tautological reasoning [cf. 62,63].

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If a questionnaire for measuring religiosity/spirituality is to be selected for use in a specific study, it

should be considered which component of the suggested model should be addressed and which instrument relates to the respective component as clearly as possible. One has to recognize that all instruments may measure just a specific facet of a complex construct. Thus, it is also worthwhile to select
more than one instrument in order to study the interplay of several components. The identification of
an appropriate measure is not always an easy task. Questionnaires may actually represent a mixture of
several components and, furthermore, the labeling of the scales may be misleading. In these cases only
a careful inspection of the wording of the items can give more precise information about the primary
measurement intention of the instrument.
4. Religiosity vs. Spirituality
In their instructive article, Zinnbauer and Pargament [64] discuss several possibilities how to differentiate religion/religiosity and spirituality. In essence, they show that either religion or spirituality can
reasonably be understood as the broader construct, depending on the concrete definitions and interrelations of the respective concepts. This highlights the necessity of explicit and clear definitions of the
phenomena which are to be assessed. We do not want to repeat the arguments and would like to refer
interested readers to the discussion of Zinnbauer and Pargament [64] as well as to complementary
statements of other authors [e.g., 65-67]. Instead, what should be pointed out here is that there is a
growing number of persons, in particular in the so-called Western world, who identify themselves as
spiritual or even as spiritual, but not religious. If these individuals are to be surveyed, concepts of
spirituality are needed which encompass non-religious beliefs and practices. Some considerations for a
corresponding model are discussed below.
Koenig [62] raised concerns about measuring spirituality in research. He stated that spirituality was
traditionally a subset of deeply religious people, while today it is including religion but expanding
beyond it. In fact, spirituality is often understood today as a broader and also changing concept which
may overlap with secular concepts (cf. Figure 1A) such as humanism, existentialism, and probably also
with specific esoteric views. Particularly in Western societies we have to acknowledge people who regard themselves as spiritual, but not religious. Several of them follow more individual and pluralistic
approaches. Some might be offended by institutional religiosity and thus are not belonging to a particular traditional religious system.
With respect to a self-categorization of German patients with chronic pain diseases for example
(82% with a Christian denomination), 50% would not regard themselves as religious, i.e., 42% regard
themselves as neither religious nor spiritual (RS), 8% as not religious but spiritual (RS+), while
32% regard themselves as religious but not spiritual (R+S) and 18% as both religious and spiritual
(R+S+) [68]. It is not surprising that spiritual/religious convictions and attitudes (i.e., Search for support / access to a spiritual source or Trust in a higher source) and specific forms of practices (religious,
spiritual, existential, humanistic) differ significantly between these self-categorizations [69,70]. Indeed, Trust was expressed as highly significant in both religious and spiritual patients (R+S+, R+S,
RS+) and accordingly correlated strongly with conventional religious practices and gratitude/reverence, while Search was expressed highly only in spiritual (R+S+ and RS+) individuals and
correlated best with both conventional religious and spiritual (mind-body) practices.

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Lazenby [71] suggested differentiating between religions (implying individuals who follow different religious traditions) on the one hand, and the concepts religion and spirituality on the other
hand, which are regarded as immediate reactions to life. For example, the Brief RCOPE uses language that selects for people who identify with a specific religious tradition, and thus it studies only
those who belong to an object under the concept of religions [71]. In contrast, the Faith subscale of
the FACIT-Sp is regarded to be associated with the concept of religions, while the Peace/Meaning
subscale measures an independent dimension which Lazenby [71] calls spirituality.
Today, religion is often understood as an institutional and culturally determined approach which organizes the collective experiences of people into a closed system of beliefs and practices [72]. Profound spiritual experiences, however, are often highly individual and not easily communicated and
shared by a group of people. Thus, spirituality is a complex and multi-dimensional issue, and can be
defined as an individual and open approach in the search for meaning and purpose in life [73]. Puchalski et al. [74] also attributed the existential search for meaning and purpose to the concept of spirituality: the aspect of humanity that refers to the way individuals seek and express meaning and
purpose and the way they experience their connectedness to the moment, to the self, to others, to nature, and to the significant or sacred. Spirituality can then be found through religious engagement,
through an individual experience of the divine, and/or through a connection to nature [62]. Thus, particularly in secular societies one should be aware that there are people which experience spirituality in
religion (which takes place within religious traditions and their institutions) while others experience
spirituality as opposed to religion (which rejects organized religiosity).
One cannot ignore that broader conceptualizations of spirituality may be less specific for particular
religious denominations. To overcome this problem, one could differentiate various aspects of spirituality which are either relevant for (or even shared by) distinct religious traditions or particularly by
secular people. To measure a wide variety of important aspects of spirituality, Bssing [75] analyzed
the answers of expert representatives of various spiritual orientations which aspects of spirituality are
relevant to them (i.e., Catholics, Protestants, members of the Anthroposophic Christengemeinschaft,
Bah, Muslims, Jews, Buddhists, and atheists). The identified motifs were condensed to a questionnaire which primarily differentiates seven core factors, i.e., Religious Orientation (prayer, trust in God,
shelter); Insight, awareness and wisdom; Transcendence conviction; Compassion, generosity and patience; Conscious interactions; Gratitude, reverence and respect; and Equanimity [76]. Finally, one can
differentiate four main categories: (1) Religious orientation (i.e., praying, trust in God, feeling
guided/sheltered etc.) (2) Search for insight/wisdom (i.e., philosophical and existential views), (3)
Conscious interactions (i.e., relational consciousness, compassion, generosity) and (4) Transcendence
conviction (i.e., rebirth, higher powers/beings, higher dimension, etc.) [77]. Similar attempts to measure different aspects of spirituality can be found in the FACIT-Sp which differentiates Faith, Meaning
and Peace [60], in the SWBQ which differentiates Personal, Transcendental, Environmental, and
Communal Well-being [58], in the SpNQ which differentiates Religious Needs, Inner Peace, Existential Needs (Reflection/Meaning), and Actively Giving [53], and in several other instruments.
Therefore, spirituality could be viewed as a general concept which may include specific views and
practices of formal religiosity, which may nevertheless share aspects of secular humanism and existentialism (Figure 2A). To capture a wide variety of spiritual convictions and attitudes, these dimensions
could be measured independently, i.e., formal religiosity, experiential aspects of spirituality (transcen-

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dence experience), existential aspects, and secular humanism (Figure 2B). While this differentiation
can be important in countries with a more secular background (i.e., Europe), this distinction might be
meaningless in countries with conservative but vital religious beliefs.
Figure 2. Overlapping constructs of spirituality, religiosity, and secular aspects. Depending on the respective model, religiosity can be conceptualized as an integral aspect of a
broader concept of spirituality, which may also share aspects with secular features (A).
Thus, instruments that rely on this broader conceptualization may be highly unspecific.
Alternatively one could specifically address defined aspects of spirituality as independent
(yet interconnected) dimensions (B).



(meaning / purpose)


5. Concluding Remarks
In this paper we first suggested that the well-known vulnerability-stress-model [28,29] can appropriately be used for locating different religious/spiritual components along a hypothetical path between
stressors and health. This may serve as a reasonable basis for categorizing measures of religiosity/spirituality according to their primary measurement intention. Before choosing a questionnaire for
use in a specific study it should thoroughly be reflected which religious/spiritual component or components should be addressed and which instruments ensure conceptually clear-cut operationalizations.
In many cases, reliable information about the primary measurement intention of the instrument can only be derived through a careful inspection of the wording of the items.
The wording of the items is also important when decisions have to be made between instruments using a specific religious terminology and instruments referring to a broader variety of worldviews.
Thus, instruments with a very particular religious perspective and traditional religious terminology are
less suited for individuals with an atheistic or agnostic background, who nevertheless may appreciate
pluralistic forms of spirituality. Beyond the differentiations between religiosity and spirituality, it is
crucial to ensure that the respondents understand the items and consider the contents to be appropriate.

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We argue that the distinction between religiosity and spirituality is especially important in countries
with a more secular background where a growing number of people identify themselves as spiritual,
but not religious.
Of course, in selecting appropriate questionnaires, many more issues should also be considered,
amongst others psychometric properties, length of the instruments, and the possibility for comparisons
with prior studies [43]. We do not argue that these more technical criteria should be neglected. But
sometimes it seems to be worthwhile to step back and reflect about measurement intentions and item
wording. This should help to choose questionnaires tailored to the specific study design as well as to
Klein, C., Berth, H., Balck, F., Eds. Gesundheit Religion Spiritualitt. Konzepte, Befunde und
Erklrungsanstze; Juventa: Weinheim, Germany, 2011.
2. Koenig, H.G.; McCullough, M.E.; Larson, D.B. Handbook of Religion and Health; Oxford
University Press: New York, NY, USA, 2001.
3. Plante, T.G., Sherman, A.C., Eds. Faith and Health. Psychological Perspectives; Guilford: New
York, NY, USA, 2001.
4. Miller, L.; Kelley, B.S. Relationships of religiosity and spirituality with mental health and
psychopathology. In Handbook of the Psychology of Religion and Spirituality; Paloutzian, R.F.,
Park, C.L., Eds.; Guilford: New York, NY, USA, 2005; pp. 460-478.
5. Chida, Y.; Steptoe, A.; Powell, L.H. Religiosity/spirituality and mortality. Psychother. Psychosom.
2009, 78, 81-90.
6. Exline, J.J. The picture is getting clearer, but is the scope too limited? Three overlooked questions
in the psychology of religion. Psychol. Inq. 2002, 13, 245-247.
7. Exline, J.J.; Rose, E. Religious and spiritual struggles. In Handbook of the Psychology of Religion
and Spirituality; Paloutzian, R.F., Park, C.L., Eds.; Guilford: New York, NY, USA, 2005;
pp. 315-330.
8. Sherman, A.C.; Simonton S. Religious involvement among cancer patients. Associations with
adjustment and quality of life. In Faith and Health. Psychological Perspectives; Plante, T.G.,
Sherman, A.C., Eds.; Guilford: New York, NY, USA, 2001; pp. 167-194.
9. Pargament, K.I. The Psychology of Religion and Coping. Theory, Research, Practice; Guilford:
New York, NY, USA, 1997.
10. Pargament, K.I.; Ano, G.G.; Wachholtz, A.B. The religious dimension of coping: Advances in
theory, research, and practice. In Handbook of the Psychology of Religion and Spirituality;
Paloutzian, R.F., Park, C.L., Eds.; Guilford: New York, NY, USA, 2005; pp. 479-495.
11. Pargament, K.I.; Ensing, D.S.; Falgout, K.; Olsen, H.; Reilly, B.; Van Haitsma, K.; Warren, R.
God help me: (I): Religious coping efforts as predictors of the outcomes to significant negative
life events. Am. J. Community Psychol. 1990, 18, 793-824.
12. Winter, U.; Hauri, D.; Huber, S.; Jenewein, J.; Schnyder, U.; Kraemer, B. The psychological outcome of religious coping with stressful life events in a Swiss sample of church attendees.
Psychother. Psychosom. 2009, 78, 240-244.

Religions 2011, 2


13. Zwingmann, C.; Mller, C.; Krber, J.; Murken, S. Religious commitment, religious coping and
anxiety: A study in German patients with breast cancer. Eur. J. Cancer Care 2008, 17, 361-370.
14. Belzen, J.A.; Hood, R.W. Methodological issues in the psychology of religion. Toward another
paradigm? J. Psychol. 2006, 140, 5-28.
15. Wulff, D.M. Empirical research on religion: Perspectives from the psychology of religion. In Religion: Immediate Experience and the Mediacy of Research. Interdisciplinary Studies in Objectives,
Concepts and Methodology of Empirical Research in Religion; Heimbrock, H.-G., Scholtz, C.,
Eds.; Vandenhoeck & Ruprecht: Gttingen, Germany, 2007; pp. 259-273.
16. Peterson, L.R.; Roy, A. Religiosity, anxiety, and meaning and purpose. Rev. Relig. Res. 1985, 27,
17. Argyle, M. Causes and correlates of happiness. In Well-Being: The Foundations of Hedonic Psychology; Kahneman, D., Diener, E., Schwarz, N., Eds.; Russell Sage Foundation: New York, NY,
USA, 1999; pp. 353-373.
18. Argyle, M. Psychology and Religion. An Introduction; Routledge: London, UK, 2000.
19. Bower, J.E.; Epel, E.; Moskowitz, J.T. Biological correlates: How psychological components of
benefit finding may lead to physiological benefits. In Medical Illness and Positive Life Change.
Can Crisis Lead to Personal Transformation? Park, C.L., Lechner, S.C., Antoni, M.H., Stanton,
A.L., Eds.; American Psychological Association: Washington, DC, USA, 2009; pp. 155-172.
20. Park, C.L. Religion and meaning. In Handbook of the Psychology of Religion and Spirituality; Paloutzian, R.F., Park, C.L., Eds.; Guilford: New York, NY, USA, 2005; pp. 295-314.
21. Park, C.L. Religion as a meaning-making framework in coping with life stress. J. Soc. Issues
2005, 61, 707-729.
22. Park, C.L. Religiousness/spirituality and health: A meaning systems perspective. J. Behav. Med.
2007, 30, 319-328.
23. Park, C.L.; Folkman, S. Meaning in the context of stress and coping. Rev. Gen. Psychol. 1997, 1,
24. Drr, A. Religiositt und psychische Gesundheit. Zur Zusammenhangsstruktur spezifischer
religiser Konzepte; Kovac: Hamburg, Germany, 2001.
25. Oman, D.; Thoresen, C.E. Do religion and spirituality influence health? In Handbook of the Psychology of Religion and Spirituality; Paloutzian, R.F., Park, C.L., Eds.; Guilford: New York, NY,
USA, 2005; pp. 435-459.
26. Pargament, K.I. Spiritually Integrated Psychotherapy. Understanding and Addressing the Sacred;
Guilford: New York, NY, USA, 2007.
27. Pargament, K.I. Is religion nothing but...? Explaining religion versus explaining religion away.
Psychol. Inq. 2002, 13, 239-244.
28. Ingram, R.E.; Price, J.M. Vulnerability to Psychopathology. Risk Across the Lifespan; Guilford:
New York, NY, USA, 2001.
29. Zuckerman, M. Vulnerability to Psychopathology. A Biosocial Model; American Psychological
Association: Washington, DC, USA, 1999.
30. Klein, C.; Albani, C. Religiositt und psychische Gesundheit empirische Befunde und
Erklrungsanstze. In Gesundheit Religion Spiritualitt. Konzepte, Befunde und

Religions 2011, 2









Erklrungsanstze; Klein, C., Berth, H., Balck, F., Eds.; Juventa: Weinheim, Germany, 2011;
pp. 212-242.
Klein, C.; Albani, C. Die Bedeutung von Religion fr die psychische Befindlichkeit: Mgliche
Erklrungsanstze und allgemeines Wirkmodell. Zeitschrift fr Nachwuchswissenschaftler 2011,
Moberg, D.O. Spiritual Well-Being: Background and Issues; White House Conference on Aging:
Washington, DC, USA, 1971.
Paloutzian, R.F.; Ellison, C.W. Loneliness, spiritual well-being and the quality of life. In Loneliness: A Sourcebook of Current Theory, Research and Therapy; Peplau, L.A., Perlman, D., Eds.;
Wiley: New York, NY, USA, 1982; pp. 224-237.
Canada, A.L.; Murphy, P.E.; Fitchett, G.; Peterman, A.H.; Schover, L.R. A 3-factor model for the
FACIT-Sp. Psychooncology 2008, 17, 908-916.
Whitford, H.S.; Olver, I.N. The multidimensionality of spiritual wellbeing: Peace, meaning, and
faith and their association with quality of life and coping in oncology. Psychooncology 2011,
doi: 10.1002/pon.1937, [Epub ahead of print].
Fisher, J.W.; Francis, L.J.; Johnson, P. Assessing spiritual health via four domains of well-being:
The SH4DI. Pastoral Psychol. 2000, 49, 133-145.
Fisher, J. Development and application of a spiritual well-being questionnaire called SHALOM.
Religions 2010, 1, 105-121.
Hackney, C.H.; Sanders, G.S. Religiosity and mental health: A meta-analysis of recent studies. J.
Sci. Stud. Relig. 2003, 42, 43-55.
Huber, S. Zentralitt und Inhalt. Ein neues multidimensionales Messmodell der Religiositt; Leske
& Budrich: Opladen, Germany, 2003.
Huber, S. Kerndimensionen, Zentralitt und Inhalt. Ein interdisziplinres Modell der Religiositt.
Journal fr Psychologie 2008, 16, Article 05,
Glock, C.Y. On the study of religious commitment. Relig. Educ. 1962, 57 (Suppl.), 98-110.
Stark, R.; Glock, C.Y. American Piety: The Nature of Religious Commitment; University of California Press: Berkeley, CA, USA, 1968.
Zwingmann, C.; Klein, C.; Hfling, V. Messung von Religiositt/Spiritualitt im Rahmen der
Gesundheitsforschung: Ein berblick ber deutschsprachige Fragebogenskalen. In Gesundheit
Religion Spiritualitt. Konzepte, Befunde und Erklrungsanstze; Klein, C., Berth, H., Balck,
F., Eds.; Juventa: Weinheim, Germany, 2011; pp. 65-91.
Allport, G.W.; Ross, J.M. Personal religious orientation and prejudice. J. Pers. Soc. Psychol.
1967, 5, 432-443.
Williams, D.R. Commitment. In Multidimensional Measurement of Religiousness/Spirituality for
Use in Health Research: A Report of the Fetzer Institute / National Institute on Aging Working
Group; Fetzer Institute, Ed.; Fetzer Institute: Kalamazoo, MI, USA, 2003; pp. 71-74.
Lehr, D.; Klein, C.; Huber, S. Zentralitt der Religiositt in der Persnlichkeit. Teststatistische
Prfung und Normierung der Zentralittsskala Z7 in Deutschland, sterreich und der Schweiz.
Diagnostica 2011, Forthcoming.

Religions 2011, 2


47. Hood, R.W. The construction and preliminary validation of a measure of reported mystical experience. J. Sci. Stud. Relig. 1975, 14, 29-41.
48. Piedmont, R.L. Does spirituality represent the sixth factor of personality? Spiritual transcendence
and the five-factor model. J. Pers. 1999, 67, 985-1013.
49. Holland, J.C.; Kash, K.M.; Passik, S.; Gronert, M.K.; Sison, A.; Lederberg, M.; Russak, S.M.;
Baider, L.; Fox, B. A brief spiritual beliefs inventory for use in quality of life research in lifethreatening illness. Psychooncology 1998, 7, 460-469.
50. Richards, P.S.; Smith, T.B.; Schowalter, M.; Richard, M.; Berrett, M.E.; Hardman, R.K. Development and validation of the theistic spiritual outcome survey. Psychother. Res. 2005, 15,
51. Hermann, C. Development and testing of the spiritual needs inventory for patients near the end of
life. Oncol. Nurs. Forum 2006, 33, 737-744.
52. Bssing, A.; Balzat, H.J.; Heusser, P. Spirituelle Bedrfnisse von Patienten mit chronischen
Schmerz- und Tumorerkrankungen. Perioperative Medizin 2009, 1, 248.
53. Bssing, A.; Balzat, H.J.; Heusser, P. Spiritual needs of patients with chronic pain diseases and
cancer Validation of the Spiritual Needs Questionnaire. Eur. J. Med. Res. 2010, 15, 266-273.
54. Pargament, K.I.; Smith, B.W.; Koenig, H.G.; Perez, L.M. Patterns of positive and negative religious coping with major life stressors. J. Sci. Stud. Relig. 1998, 37, 710-724.
55. Pargament, K.I.; Koenig, H.G.; Perez, L.M. The many methods of religious coping: Development
and initial validation of the RCOPE. J. Clin. Psychol. 2000, 56, 519-543.
56. Pargament, K.I.; Kennell, J.; Hathaway, W.; Grevengoed, N.; Newman, J.; Jones, W. Religion and
the problem-solving process: Three styles of coping. J. Sci. Stud. Relig. 1988, 27, 90-104.
57. Ellison, C.W. Spiritual well-being: Conceptualization and measurement. J. Psychol. Theol. 1983,
11, 330-340.
58. Gomez, R.; Fisher, J.W. Domains of spiritual well-being and development and validation of the
Spiritual Well-Being Questionnaire. Pers. Individ. Dif. 2003, 35, 1975-1991.
59. Gomez, R.; Fisher, J.W. The Spiritual Well-Being Questionnaire: Testing for model applicability,
measurement and structural equivalencies and latent mean differences across gender. Pers.
Individ. Dif. 2005, 39, 1383-1393.
60. Peterman, A.H.; Fitchett, G.; Brady, M.J.; Hernandez, L.; Cella, D. Measuring spiritual well-being
in people with cancer: The Functional Assessment of Chronic Illness Therapy Spiritual Wellbeing Scale (FACIT-Sp). Ann. Behav. Med. 2002, 24, 49-58.
61. Bredle, J.M.; Salsman, J.M.; Debb, S.M.; Arnold, B.J.; Cella, D. Spiritual Well-Being as a component of health-related quality of life: The Functional Assessment of Chronic Illness Therapy
Spiritual Well-Being Scale (FACIT-Sp). Religions 2011, 2, 77-94.
62. Koenig, H.G. Concerns about measuring spirituality in research. J. Nerv. Ment. Dis. 2008, 196,
63. Sloan, R.P.; Bagiella, E.; Powell, T. Religion, spirituality, and medicine. Lancet 1999, 353,
64. Zinnbauer, B.J.; Pargament, K.I. Religiousness and spirituality. In Handbook of the Psychology of
Religion and Spirituality; Paloutzian, R.F., Park, C.L., Eds.; Guilford: New York, NY, USA,
2005; pp. 21-42.

Religions 2011, 2


65. Fuller, R. Spiritual, but not Religious. Understanding Unchurched America; Oxford University
Press: New York, NY, USA, 2001.
66. Hood, R.W. Spirituality and religion. In Religion: Critical Approaches to Drawing Bounderies
between Sacred and Secular; Greil, A.L., Bromley, D.G., Eds.; Elsevier: Amsterdam, The Netherlands, 2003; pp. 241-264.
67. Utsch, M.; Klein, C. Religion, Religiositt, Spiritualitt. Bestimmungsversuche fr komplexe
Begriffe. In Gesundheit Religion Spiritualitt. Konzepte, Befunde und Erklrungsanstze;
Klein, C.; Berth, H.; Balck, F., Eds.; Juventa, Weinheim: Germany, 2011; pp. 25-45.
68. Bssing, A.; Michalsen, A.; Balzat, H.J.; Grnther, R.A.; Ostermann, T.; Neugebauer E.A.M.;
Matthiessen, P.F. Are spirituality and religiosity resources for patients with chronic pain conditions?
Pain Med. 2009, 10, 327-339.
69. Bssing, A.; Matthiessen, P.F.; Ostermann, T. Engagement of patients in religious and spiritual
practices: Confirmatory results with the SpREUK-P 1.1 questionnaire as a tool of quality of life
research. Health Qual. Life Out. 2005, 3, 53.
70. Bssing, A. The SpREUK-SF10 questionnaire as a rapid measure of spiritual search and religious
trust in patients with chronic diseases. Zhong Xi Yi Jie He Xue Bao 2010, 8, 832-841.
71. Lazenby, J.M. On spirituality, religion, and religions: A concept analysis. Palliat. Support.
Care 2010, 8, 469-476.
72. Mueller, P.S.; Plevak, D.J.; Rummans, T.A. Religious involvement, spirituality, and medicine:
Implications for clinical practice. Mayo Clin. Proc. 2001, 76, 1225-1235.
73. Bssing, A.; Ostermann, T.; Matthiessen, P.F. Role of religion and spirituality in medical patients:
Confirmatory results with the SpREUK questionnaire. Health Qual. Life Out. 2005, 3, 10.
74. Puchalski, C.; Ferrell, B.; Virani, R.; Otis-Green, S.; Baird, P.; Bull, J.; Chochinov, H.; Handzo,
G.; Nelson-Becker, H.; Prince-Paul, M.; Pugliese, K.; Sulmasy, D. Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. J. Palliat.
Med. 2009, 12, 885-904.
75. Bssing, A. Spiritualitt Worber reden wir? In Spiritualitt, Krankheit und Heilung Bedeutung und Ausdrucksformen der Spiritualitt in der Medizin; Bssing, A., Ostermann, T., Glckler,
M., Matthiessen, P.F., Eds.; Verlag fr Akademische Schriften: Frankfurt am Main, Germany,
2006; pp. 11-24.
76. Bssing, A.; Ostermann, T.; Matthiessen, P.F. Distinct expressions of vital spirituality. The ASP
questionnaire as an explorative research tool. J. Relig. Health 2007, 46, 267-286.
77. Bssing, A.; Fller-Mancini, A.; Gidley, J.; Heusser, P. Aspects of spirituality in adolescents. Int.
J. Child. Spiritual. 2010, 15, 25-44.
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